Obesity is Also in Your Head

Dov Michaeli

Posted 2/14/12 on The Doctor Weighs In

Incredulous Dov

More than 300 million people worldwide are considered obese (BMI >30) and more than a billion people are classified as overweight (BMI 25-30). This is a global epidemic that puts to shame such well-known epidemics as the black plague of the 14th century, which wiped out about a third of the European population. So what does this epidemic wipe out? among other things, your memory. Quite surprising, considering that our attention is riveted by the cardiovascular and renal effects of type 2 diabetes.

New research suggests that consuming between 2,100 and 6,000 calories per day may double the risk of memory loss, or mild cognitive impairment (MCI), among people age 70 and older. The study will be presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans April 21 to April 28, 2012. MCI is the stage between normal memory loss that comes with aging and early Alzheimer’s disease.

Continue reading “Obesity is Also in Your Head”

A Population-Based Care Management Lesson: What Telephonic Disease Management Lacks In Individual Effectiveness Is Made Up By Its Greater Reach

Jaan Sidorov

Posted 11/17/11 on the Disease Management Care Blog

In yesterday’s post on the role of telephonic disease management for obesity, the Disease Management Care Blog pointed out that POWER was a landmark study that demonstrated that remote lifestyle counseling performed as well as traditional face-to-face counseling.

New England Journal of Medicine editorial accompanying thePOWER article points out that there may have been an additional factor that explained the results: patient attendance at the in-person counseling sessions dropped off precipitously as the trial progressed (an average of only 2 out of 24 scheduled visits after the seventh month), while the telephonic approach achieved 16 out of 18 scheduled contacts.

The DMCB agrees and suggests this is an additional virtue of remote telephonic disease management.  While in-person counseling may have more of an individual impact, it does little good if  patients no-show.  In contrast, “high volume” telephonic counseling may have more of a population-based effect, because a lower intensity intervention has greater absolute impact if it’s delivered to morepersons.

NIH scientist Susan Yanovski’s editorial falls short on capitalizing on that insight.  While it grudgingly points out that POWER shows “PCPs can deliver safe and effective weight-loss interventions in primary care settings,” it neglects to mention the two important implications of POWER:

1) non-physician team members acting in collaboration with PCPs are an important resource in the national battle against obesity and

2) offering a variety of communication channels increases reach and gives more patients new and effective options to access anti-obesity programs.

Practical Approaches to Obesity Care and Chronic Illness In Busy Clinical Settings: Three Key Ingredients

Jaan Sidorov

First posted 9/27/11 on the Disease Management Care Blog

If anything is true about the population health management service providers, they are constantly looking for better ways to fit their programs into busy clinical settings.

That’s why this article on New and Emerging Weight Management Strategies for Busy Ambulatory Settings, courtesy of the American Heart Association, should be “must” reading for the vendor industry.  It’s chock full of practical advice on how to “engineer” the PHM-physician partnership. While the focus of the article is on a practical approach to obesity, its approach can be applied to other conditions, such as diabetes or tobacco abuse.

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Who Is The Fattest Of Them All?

Patricia Salber

First posted 7/20/11 on The Doctor Weighs In

What state has the highest rate of obesity in the land?  If you guessed Mississippi, you would be correct.  For the seventh straight year, Mississippi tops the list of the “Fattest States in the Nation.”  When they first took possession of this top ranking of one of the nation’s most infamous lists of unhealthiness, the rate of obesity was just 19.4%.  Now, they are almost unbeatable with a (whopping) rate of 34.4%.  Congratulations, Mississippi.  You are the fattest of them all.

Most people knowledgeable about obesity in the US know that is it going to take a multi-pronged effort to reduce obesity – one of the leading causes of death in this country because it is the fuel for Type 2 diabetes and associated conditions, such as hypertension, heart disease and stroke.

Folks who don’t really understand the complexities of obesity like to blame the fatties – you have heard it:  “they have no will power, they don’t exercise, they don’t this and they don’t that.”  These “personal responsibility advocates” are not willing to put on the table societal contributing factors, such as the following:

  • Ubiquitous presence of fast food restaurants and their seductive advertising ploys
  • Lack of full service grocery stores in some low income neighborhoods – you  can buy alcohol in its various forms, but not fresh fruits and vegetables
  • Lack of health literacy – because this is not a priority in our schools
  • Poverty – a Big Mac may be cheaper than a couple of tomatoes from the farmer’s market
  • Exercise-unfriendly neighborhoods – unsafe streets, no exercise facilities, no support

Continue reading “Who Is The Fattest Of Them All?”

The End of Overeating, By David Kessler, MD

Here’s a promo for a book, The End of Overeating, by David Kessler, MD, the Harvard-trained doctor, lawyer, medical school dean and former commissioner of the Food and Drug Administration. It is here, not as a plug, but because it conveys an extremely important message that we want to make available to physicians and other clinicians. The thesis is that the food industry uses science to seduce us into eating things that are terribly detrimental. There are solutions. Take 4 minutes and watch.